Operational Performance

Delivery of high-quality patient care and financial viability depend heavily on operational excellence. All aspects of an organization’s business or care practices can benefit from periodic review and systematic improvement planning. Health Dimensions Group (HDG) supports that effort through a number of operational performance improvement processes.

PDPM Post-Implementation Support

Effective October 1, 2019, the Centers for Medicare and Medicaid Services (CMS) replaced the Resource Utilization Groups (RUGs) payment system with a new model called Patient-Driven Payment Model (PDPM) for Medicare Part A payment for skilled nursing facility (SNF) care.

PDPM presents new opportunities for providers to manage costs and to expand into new service lines. However, it also comes with challenges such as mastering operational complexities, ensuring complete and accurate coding, and changing the culture. Those challenges will exist into the future as competitors adjust to the new payment model and CMS makes adjustments in response to system-wide behavioral changes (e.g., coding creep adjustments and payment weight recalibration).

In some markets and for many providers, the changes will be significant and will require changes to facility operating systems and strategic repositioning. Understanding the new system will be critical to future success. To assist your organization in assessing the impact of the PDPM transition for your Medicare-certified SNFs, HDG offers operational readiness assessments, education, financial and market analyses, and ongoing clinical support.

Operational Performance Assessments

Our team helps you discover where the opportunities for improvement lie and advises you on ways to leverage your community’s potential—clinically, operationally, and financially. It is essential for you to understand how your community compares and contrasts to its peer group, locally and nationally. We work with you to analyze the full spectrum of your operation and identify opportunities including revenue optimization, cost reduction, and care improvement.

Regulatory Compliance Audits

Prior to expected or increased regulatory oversight, organizational leadership is often looking to stress-test certain aspects of their operations to assess vulnerabilities and establish baselines from which to improve. HDG consultants thoroughly audit policies, procedures, and current practices to determine regulatory compliance regarding state and federal regulations for post-acute care, long-term care, and senior living communities. These evaluations include health and Life Safety components of regulatory testing.

Mock Surveys

A Mock Survey provides senior care communities with an opportunity to receive an unbiased assessment of your processes, systems, and quality of care. HDG’s customized approach includes a site visit that mirrors the required annual surveys of skilled nursing facilities and nursing homes to assess compliance with minimum standards for rules and regulations. The Mock Survey also includes an evaluation of core clinical systems, necessary modifications to policies and procedures, compliance with Mega Rule, and an assessment of quality assurance and performance improvement (QAPI) processes.

Sales, Marketing, and Occupancy Development

Post-acute care providers and operators face an ever-changing and competitive landscape. More than ever before, providers depend on partnerships with others in the continuum, including referring providers, consumers, and payors. Providers must leverage these relationships to sustain command of desired market share, which drives occupancy and revenue. Our consultants work closely with you to explore referral dynamics, sales processes, and marketing strategies to position you as a preferred referral and living destination.

Turnaround Solutions

Operational Turnaround

For a variety of reasons, long-suffering skilled nursing and senior living operators often defer making the tough decisions needed to keep an operation sustainable. Declining occupancy and payor mix, poor regulatory outcomes, and workforce challenges combine to create a vortex that is difficult to reverse. HDG’s diverse team of turnaround consultants with decades of experience specialize in these complex scenarios. We provide oversight to help stabilize operations through completion of a comprehensive assessment and execution of a customized performance improvement plan. Our consulting resources provide support in an array of areas including operations, occupancy and case-mix development, regulatory compliance, clinical reimbursement, revenue cycle management, and human resources.

Financial Turnaround

HDG provides turnaround solutions for organizations experiencing financial difficulties. Our finance, operations, and clinical consulting team is deeply experienced in managing organizations through difficult financial situations. Our approach is to perform a thorough review of financial performance, combined with an assessment of operations, clinical capabilities, and payor environment, to determine the optimal solution for financial success. We provide the assistance and support needed to implement and execute the recommended solution.

Clinical Turnaround

For organizations challenged by rising clinical complexity, regulatory volatility, and an increased risk-based environment, HDG offers clinical consulting services to assist long-term care and senior living providers in developing skills, approaches, and tools to achieve successful clinical operations. Our experienced consultants provide clinical programs, leadership development, and strategic planning and direction to navigate the ever-changing health care landscape. HDG delivers measurable results and creative, solid solutions in areas such as mock regulatory compliance surveys; post-survey turnaround support; five-star rating quality improvement best practices; and clinical system reviews.

Regulatory Turnaround

Local or national regulatory policies can often have a profound effect on an organization’s nimbleness during challenging times. Understanding the overall policy landscape, as well as the particulars of rules and emerging practices, can often be one of the keys to identifying and overcoming barriers and seizing on opportunities. HDG decodes complex rules and presents options in a digestible format for client success.


HDG’s divestiture consulting and owner’s representation services help prepare businesses for the divestiture process. When a decision has been made to divest and transition the business or asset, we also assist in navigating those myriad steps. HDG’s assistance to sellers comprises: operational improvements to optimize asset value; financial analysis and divestiture valuation; identification of potential bidders; engagement with brokers; due diligence; oversight of necessary communications; and general direction and guidance throughout the process.

Occupancy and Census Development

HDG assists providers in occupancy and census development by analyzing their competition in areas such as number of units, occupancy, pricing structure, and market niche. In addition, HDG analyzes the demographics of the market area to determine current population estimates and five-year population projections, which drive demand for each senior living service line. HDG also assesses key metrics, current sales and marketing strategies and tactics, and sales personnel, and provides ongoing staff coaching and training.

Case study: find out how HDG led a SNF with inexperienced leadership to regulatory compliance through our mock survey services.

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Why work
with HDG


As managers and consultants in senior living, post-acute, and long-term care, we are familiar with the challenges our clients face every day. Caring Above and Beyond, our proven process, supports those we serve through four Pillars of Excellence: Quality/Customer Experience, People, Financial, and Sales and Marketing.


Aging services are our focus, resulting in an unparalleled depth of knowledge. Our seasoned and highly skilled professionals ensure customized solutions specific to our clients’ unique circumstances.


Guided by an unwavering commitment to our values of hospitality, stewardship, integrity, respect, and humor, we have served the nation’s leading providers and industry partners for over 20 years.

We’re here to help.